<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0">
    <meta http-equiv="X-UA-Compatible" content="ie=edge">
    <title>survey</title>
</head>
<body>
    <h1>American Metric 电子产品调查问卷</h1>
    <table>
            <tr>
                    <td>
                        <label for="姓名">姓名:</label>
                    
                        <input type="text" placeholder="输入必须是二到六位的字符" name="姓名" id="姓名">
                    </td> 
                </tr>
        <tr>
            <td>
                <label for="date">购买日期:</label>
            
                <select name="date" id="date">
                    <option value="year">2018</option>
                </select>
        
                <select name="date" id="date">
                    <option value="month" selected="selected">1月</option>
                    <option value="month">2月</option>
                    <option value="month">2月</option>
                    <option value="month">4月</option>
                    <option value="month">5月</option>
                    <option value="month">6月</option>
                    <option value="month">7月</option>
                    <option value="month">8月</option>
                    <option value="month">9月</option>
                    <option value="month">10月</option>
                    <option value="month">11月</option>
                    <option value="month">12月</option>
                </select>
                <select name="day" id="day">
                    <option value="day" selected="selected">1日</option>
                    <option value="day">2日</option>
                    <option value="day">3日</option>
                    <option value="day">4日</option>
                    <option value="day">5日</option>
                    <option value="day">6日</option>
                    <option value="day">7日</option>
                    <option value="day">8日</option>
                    <option value="day">9日</option>
                    <option value="day">10日</option>
                    <option value="day">11日</option>
                    <option value="day">12日</option>
                    <option value="day">13日</option>
                    <option value="day">14日</option>
                    <option value="day">15日</option>
                    <option value="day">16日</option>
                    <option value="day">17日</option>
                    <option value="day">18日</option>
                    <option value="day">19日</option>
                    <option value="day">20日</option>
                    <option value="day">21日</option>
                    <option value="day">22日</option>
                    <option value="day">23日</option>
                    <option value="day">24日</option>
                    <option value="day">25日</option>
                    <option value="day">26日</option>
                    <option value="day">27日</option>
                    <option value="day">28日</option>
                    <option value="day">29日</option>
                    <option value="day">30日</option>
                    <option value="day">31日</option>
                </select>
            </td>
        </tr>
        <tr>
            <td>
                <label for="email">电子邮箱地址:</label>
            
                <input type="text" placeholder="2592779314@qq.com" name="email" id="email">
            </td>
        </tr>

        <tr>
            <td>
                <label for="phonenum">手机号码:</label>
            
                <input type="text"placeholder="输入必须是13,15开头的" id="phonenum" name="phonenum">
            </td>
        </tr>

        <tr>
            <td>
                您是否查看过我们在线产品目录？
                <input type="radio" value="1" name="checked" id="YES">是
                <input type="radio" value="0" name="checked" id="NO" checked>否
            </td>
        </tr>
        <tr>
            <td>
                如果查看过，您对哪些产品有兴趣购买？（选择提供的产品）
            </td>
        </tr>
        <tr>
            <td>
                    <input type="checkbox" id="interest1" name="interests" value="TV" checked="checked"/>大屏电视机
                    <input type="checkbox" id="interests2" name="interests" value="yinpin"/>音频设备
                    <input type="checkbox" id="interests3" name="interests" value="video" checked="checked"/>视频设备
                    <input type="checkbox" id="interests4" name="interests" value="Camera"/>相机
            </td>
        </tr>
        <tr>
            <td>在填写订单之前，您还有什么B话要说吗？</td>
        </tr>
        <tr>
                <td>
                        <textarea name="message" id="message" cols="30" rows="1" placeholder="您的输入"></textarea>
                    </td>
        </tr>

        <tr>
            <td>
                    <button type="reset">提交</button>
                    <button type="reset" disabled>重置</button>
            </td>
        </tr>

    </table>
</body>
</html>